ABSTRACT: Gastrointestinal Tuberculosis

Jeanne Stephanie D. Piano, MD

Ospital ng Makati Radiology Department

An 7-year-old 30kg boy came in accompanied by his mother for consult

in our institution due to abdominal pain. 13 months prior, he noticed a
palpable mass on his epigastric area with no associated symptoms. 7
months later, he sought consult due to cough and colds along with the
persistence of the palpable epigastric mass where abdominal xray
seemed to be normal. Tuberculin skin test was not performed because
tuberculosis was not considered as the cause hence patient was
managed as a case of pneumonia. 2 days prior, he was noted to have
fever, with associated epigastric pain, still with the palpable abdominal
mass.
Ultrasound of the abdomen was done which revealed
hepatomegaly with well-defined hypoechoic foci with central
calcifications primarily suggestive of an infectious process (GI
tuberculosis) or parasitism. This was correlated with his abdominal
xray which also revealed hepatomegaly with multiple diffuse calcific
opacities in the right upper hemiabdomen. A chest xray was also
requested which had findings in both lungs suggestive of a non-specific
infectious process with prominent suprahilar regions likely representing
enlarged lymph nodes.
In the Philippines, Tuberculosis (TB) is a major health problem. It
is usually an illness of adults but it can also affect children. Pediatric
patients were between 6 months and 16 years old and occurs more
among BCG non-vaccinated children. According to WHO, one million
children (0-14 y/o) fell ill with TB and nearly 140,000 children died from
the disease. It is a potentially contagious disease with predominance of
pulmonary manifestations in most TB cases and can also involve all
parts of the gastrointestinal tract. Transmission of this disease usually
spreads from the lungs to sites outside the lungs. In some cases,
however, this may first appear extrapulmonary. Although rare, TB of
the gastrointestinal tract is characterized by long-lasting abdominal
symptoms, which may be confused with other disease entities, and
usually diagnosis is delayed varying between 1 and 14 months.
Manifestations of TB in the abdomen are diverse but most patients
present with colicky abdominal pain (80-95%), low or high grade fever
(40-70%), weight loss and in some cases may present with an
abdominal lump. Without histopathologic confirmation, identifying the
pattern of the radiologic findings can help in the diagnosis of TB. A high

clinical index of suspicion is also necessary to obtain an accurate

diagnosis.